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The Vigilant Hypochondriac

The vigilant hypochondriac: The inner ear, vision and other senses keep us upright

What causes older people to fall?

A decline in agility may prevent them from regaining their balance when they trip. Vision problems may prevent them from seeing obstacles in their path. Loss of feeling in their feet may contribute as well.

Now a researcher has shown that the vestibular system — the structure deep within the inner ear that helps us maintain our balance — deteriorates with age and also contributes to falls.

"Our data shows a significant increase in vestibular dysfunction with age," says Dr. Yuri Agrawal of Johns Hopkins University in Baltimore. "For 50-year-olds the prevalence of vestibular dysfunction is 32 percent, while among 80-year-olds it's 85 percent."

That means approximately 69 million Americans — more than one in five — will have greater difficulty maintaining their balance, making them more prone to falling.

With age, the consequences of falling become greater. After older people fall, especially if they break a hip, their average life expectancy is about six months, Agrawal said.

Fortunately, she says, the vestibular system is not the only tool we have for maintaining our balance. Our eyes provide valuable cues, and so does sensory feedback. Signals from the bottom of our feet are especially valuable because they alert us when we're walking on uneven ground.

Unfortunately, the visual and sensory systems also tend to deteriorate with age, especially in people with diabetes.

"A person can tolerate the loss of one of these systems for maintaining balance," says Agrawal, "but when you experience a decline in two or more, you're much more compromised."

What can be done about this?

Quite a bit, according to Dr. Jackie Lovejoy-Osborne, a geriatric physical therapist with the University of South Florida School of Physical Therapy & Rehabilitation Services in Tampa.

An older person who falls should be evaluated by a medical team, including a physical therapist, to see if there are ways to compensate for the losses that come with age.

"I think it's important to figure out what triggered the fall," she says. "A person is never too old to learn how to avoid those patterns that increase risk."

For example, a person with cataracts may have trouble seeing obstacles, but this problem is easily corrected with surgery.

"That's a changeable issue that would decrease the risk of falling," says Lovejoy-Osborne.

Similarly, exercises and therapy can help a person compensate for declines in agility, coordination, the sense of touch and other problems.

Even vestibular function can be improved.

"There are gaze stabilization exercises, for example," Lovejoy-Osborne says. "When the vestibular system ages or has disease-related dysfunction, the person may develop nystagmus — the eyes can no longer focus efficiently as the head turns or as the eyes attempt to track a moving object."

To help people with nystagmus strengthen their sense of balance, Lovejoy-Osborne has them sit on a solid surface, hold the king from a deck of cards at arm's length, focus on the 'K', and then shift the eyes to focus on something in the background.

"Looking at the foreground, then the background, back and forth, may make the person dizzy and affect balance," she says, "but to provoke a symptom, in this case, is to improve it."

Such simple techniques can be very effective, she says, and would help to reduce the number of falls that can be so devastating to older people.

"I feel very strongly about this, because there are so many aging people in the U.S. — especially in Florida," she says. "About 17 to 18 percent of the population here is over 65, and it's a real disservice not to screen people over 65 to see if their risk of falling can be reduced."

Tom Valeo is a freelance writer in St. Petersburg. You can reach him in care of LifeTimes, St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731.

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About this column

The Vigilant Hypochondriac explains what happens to our bodies as we age. But we don't have to go down without a fight. There are ways to ensure good health for a lifetime.

The vigilant hypochondriac: The inner ear, vision and other senses keep us upright 06/22/09 [Last modified: Monday, June 22, 2009 4:30am]

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